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J Thorac Cardiovasc Surg 2006;132:407-412
© 2006 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Long-term outcome after pulmonary retransplantation

^a Hannover Thoracic Transplant Program, Division of Thoracic- and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
^b Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany

Received for publication September 20, 2005; revisions received December 18, 2005; accepted for publication December 22, 2005.

^_* Address for reprints: Martin Strüber, MD, Director, Hannover Thoracic Transplant Program, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Carl Neuberg Str1, 30625 Hannover, Germany (Email: strueber{at}thg.mh-hannover.de).

OBJECTIVE: Bronchiolitis obliterans syndrome has become the most limiting factor for long-term outcome after lung transplantation. Redo lung transplantation was performed for end-stage bronchiolitis obliterans syndrome. Long-term outcome was compared with that after primary lung transplantation as well as with other indications for retransplantation.

METHODS: Of 614 lung transplantation procedures performed at our institution, 54 (8.5%) were redo transplants. These were stratified into different groups according to the indication for redo transplantation, including chronic graft failure/bronchiolitis obliterans syndrome, acute graft failure, and posttransplantation airway complications. Long-term survival was compared with that of the primary lung transplantation cohort, thereby respecting the need for pretransplant mechanical ventilatory support in a subanalysis. In addition, recurrence of bronchiolitis obliterans syndrome after redo lung transplantation was compared with the occurrence of bronchiolitis obliterans after primary transplantation.

RESULTS: A 1-year survival of 50% was achieved after redo lung transplantation for acute graft failure and airway complications as well as after primary lung transplantation in patients with pretransplant ventilatory support. Retransplantation for bronchiolitis obliterans syndrome revealed superior 1- (78%) and 5-year (62%) survivals, which were not different from those of first-time lung transplant recipients. In addition, we found a similar incidence of bronchiolitis syndrome after retransplantation for BOS compared with its occurrence after primary lung transplantation.

CONCLUSION: Redo lung transplantation for end-stage bronchiolitis obliterans syndrome leads to acceptable long-term outcome in selected patients. Future analyses of redo lung transplantation data should generally stratify bronchiolitis obliterans syndrome from other indications with higher mortality.

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